Spinal Fluid Leaks - Dr Ian Carrol, Stanford

[ScottTriGuy]

Thanks to @Kati for pointing this video out - its 90 minutes and was well worth my time - bonus is the q and a when a doctor in the audience is humble!

Here are my notes:

Spinal Fluid Leaks

Dr Ian Carrol, Stanford, ic38@stanford.edu

Causes:

1. hypermobility (coz durma weaker) (spontaneous)

2. calcified bone pokes hole in durma (spontaneous)

3. spinal tap / epidural / surgery (Post Dural Puncture)

- 30 – 40% of spontaneous pts have multiple leaks


Symptoms: headache, nausea, fatigue, neck pain / stiff, ridicular pain, neurological ‘weirdness’ (cognitive, memory, reading, etc), pituitary may be enlarged coz of CSF (Empty Sella Syndrome: may have low growth hormone; may hypothyroid) – also, feeling worse when standing, or later in the day: but relieved by laying down.

Misdiagnosis: POTS, Chiari Formations, EDS, Tarlov Cysts, chronic migraine, CFS, FM, (maybe Parkinson’s, one case)

Diagnosis:

- often MRI deemed ‘normal’ (“by world class docs”), thus MRI not good diagnostic tool

- CT myelogram will show abnormal

- Elevated protein in CSF

- 20% will have elevated prolactin (coz hypo-thalamus-pituitary-dissociation)

Treatment:

!st: EBP: Epidural Blood Patch (some require repeat after months, some so far so good)

2nd: Fibrin ______________

3rd: Surgery